Regular readers might recall that I’m trying to set healthy boundaries. When a leader in the push for Medicare wrote recently “New Rule: Old guard practitioners who paid $10K for their education in this field don’t get to even weigh in on federal advocacy” it was only surprising in its bluntness. It’s been clear for ages that those calling the shots don’t care what the “old guard” has to say.
As Clive James wrote about Tyrion Lannister “in an unreasonable society, to have reasoning power guarantees nothing except the additional mental suffering that accrues when circumstances remind you that you are powerless.”
I can’t manage additional mental suffering right now, and so I’ve been focusing on things where my involvement has a better chance of making a difference. Not easy when I know that giving up and checking out doesn’t help make the world a better place.
So I’m super-grateful that Lisa Rohleder is still out there, keeping an eye on things, and doing what she can to appeal to reason and to make the world a better place. Please read this post about the latest Town Hall. And also this, and this one, about Acupuncture as a business.
Just tool around the Acu Safety Nerd site. It’s a fantastic blog with many great articles, and unlike The Acupuncture Observer at the moment, putting out new content regularly.
(Admittedly, plenty of my old content is still relevant. I wrote this about insurance almost a decade ago.)
(Lisa doesn’t only write. She makes stuff happen. While I’ve been trying to work within the “system” she’s been the motivating force for the community acupuncture business model, which made huge strides in making acupuncture accessible without depending on our flawed third party payer system. AND, she’s the force behind POCA Tech, a fully accredited acupuncture school that provides an affordable education. Yet I see comments on FB dismissing her writing as “lacking solutions.” Huh?!? The lack of informed discourse on FB is one of the reasons I started this Blog, fwiw.)
And here’s another blog post worth reading, about the number of folks entering the profession in California. When things aren’t going well in California, how well can they be going elsewhere?
One last, off-topic thing. Am I the only person who wants to scream/cry/laugh/vomit when I see non-Asian, US-trained, Acupuncturists accusing non-LAcs of Cultural Appropriation for wanting to use acupuncture needles? (Hey, if you prioritize honoring the culture, how about respect for the elders?)
© Elaine Wolf Komarow and The Acupuncture Observer, 2013-2033. Unauthorized use and/or duplication of this material without express written permission from Elaine Wolf Komarow is prohibited. Excerpts and links are encouraged, provided that full and clear credit is given with specific direction to the original content.
One way or another, the acupuncture profession is changing, whether from within (preferable, and possibly includes saving the profession), or from without, which will most likely mean the demise of the profession.
I’ve had my CA L.Ac. license since 2002 and was able to practice for 18 years, even with the albatross of a massive student loan around my neck. The fact I was able to practice at all is considered a success in this profession, (a low bar) even if my student loan ballooned to twice the original price tag, and I barely made enough to “survive”, forgoing health insurance, retirement savings, any savings for that matter. I was lucky to pay my office rent. Once the pandemic hit I realized how burnt out I was from the endless grind of surviving on an acupuncturist’s real salary. And I was so very angry. I realized, painfully, that I had bought in to the 90’s view of the future of the acupuncture profession which I now recognize as pure folly.
If the acupuncture profession burns like the phoenix, which by the way things are going, it seems to be headed in that direction, then what might rise from its ashes? It’s not like the medicine will just go away. The medicine itself will outlast the American’s version of what a practitioner of Traditional Chinese Medicine is.
I think a useful question to ponder at this point, is how has this medicine lasted this long? How did it last for thousands of years in China and other Asian countries? What system was in place for the medicine to exist prior to books, even prior to writing itself? And should we consider doing that system? So what was the long enduring system that ensured the knowledge was passed down and the integrity of the medicine maintained? It was apprenticeship.
Our American system of high costs, loads of prerequisites, excruciating hours of not-so-necessary education, more high tuition, predatory student loans, pieces of paper hanging on our walls with a gold embossed sticker announcing our credentials, and etc., isn’t working. In fact, it is crashing and burning after only a mere 30 years.
I know there once was avenues for apprenticeships here in America, but mostly they’ve been eliminated because there is very little financial gain to be had. Why would the schools want to allow a low-cost route into the profession? Greed is killing this profession, with the acupuncture schools being the greediest. But the dirty secret the schools do not want you to know is there is absolutely no need for an acupuncture school ever again.
An apprenticeship system could exist in a myriad of ways:
-There could be individual acupuncturist who take on small numbers of apprentices.
-This system could possibly create incentive for acupuncturists to form some sort of group or linked practices which share apprentices so apprentices can follow different styles and focuses.
-There can be a cap on numbers to ensure quality. There can be a series to tests to ensure knowledge and proficiency along the way.
-Taking on apprentices could help existing acupuncturists make additional income, while simultaneously participating in the future of acupuncture in America and in the next generation of acupuncturist.
-Running a successful acupuncture business (missing in the acupuncture schools) is modeled and taught throughout the apprenticeship.
-Regulations and testing can exists to ensure knowledge and proficiency are happening and that apprentices do not turn into moxa-slaves.
-The tests can be cheaper, shorter, and focused on the core basics.
-I am sure there are many other ideas of how an apprenticeship style of learning can work. Look to the past and apply it to the present framework of our modern world and throw in a whole lot of commonsense.
By the way, the “Old Guard” would come in very handy in this system, as they share their important and precious knowledge and experience they have gained throughout their career.
We need to let go of fitting TCM and acupuncture into the Western Medicine model. A lot can be said about the existential differences between the two medicines which make them basically incompatible, if not antagonistic toward one another, in America. But in short, it is like trying to force a round peg into a square hole.
An although unlikely to be implemented anytime soon or possibly ever, I hope this comment reaches those that can benefit from reading it.
Thank you, Grace. I think you point to the issue that underlies all of the other issues — trying to fit this medicine into the US Medical Delivery system, which doesn’t even work for delivering Western Health Care. I believe that one of the factors that lead to turning away from the apprenticeship route was that it would not be acceptable to the US system.
Some will read about your struggles and say that the very reason we need to further “integrate” into the system is to get health insurance and retirement plans, and that may be true to the extent we’d be hired as employees. However, if you look at the bulk of health care hiring and delivery, I believe we’d need to let go of the belief that we’d be hired as “Doctors” — even though the vast majority of health care delivery is not done by the MD’s – their time is too valuable. Realistically, the vast majority of us would be hired as technicians, and I don’t find many practitioners who would agree to that.
I’m really not sure how much of the issue is the greedy schools. I know some certainly are — but it seemed to me that the drive to increase the hours of education and add/degree programs did not come from the schools. Maybe it was a false flag, or maybe I’m just ignorant, but so many of the changes to the profession seem to me to come from practitioners who have an idea and are persistent enough (and sometimes many less laudable characteristics) to force it upon the rest of us. The energy of those resisting change seems to get depleted sooner than those pushing change.
Elaine, if I may, I have comments on the Jan 18 Town Hall, and no forum on which to express them effectively.
This is in response to the Jan !8 NCCAOM Town Hall. It was suggested on a facebook forum that opinions differering from those in the presentation skewed the facts. There also was a comment on the tombstone picture (if you haven’t watched the Town Hall yet, that should get you to!). What is presented in the article https://acusafetynerd.com/heading-for-the-cliff-part-two?fbclid=IwAR1NNfHZZfwgQ3qPt7mcYw9Gpie3aFeOpT-HPAEbVTvnsI62EnNuJ0nqbVc is an opinion, and perhaps facts are skewed. The viewpoint of the NCCAOM Town Hall is an opinion, as well, with facts skewed in another direction.
A few of points.
1. First of all, the statement that ‘back in the eighties, Licensed Acupuncturists were the ONLY people practicing acupuncture’ is inaccurate. In the 1980’s LAc’s were not the only people to be practicing acupuncture. In the 1980’s, almost NO ONE got treatment from an LAc. 100% of acupuncture patients were not treated by LAc’s. Acupuncture was either illegal or not legal in most states and few states issued licenses. LAc’s mostly did not exist. Although a very few states, like CA, issued acupuncture licenses, by and large, acupuncture was fringe, and in a very precarious legal position. It is disingenuous to imply that in the decade of the 1980’s there were Licensed Acupuncturists everywhere and that all acupuncture patients went to them.
2. Acupuncture as a low cost and effective treatment: Yes, effective, but these days, except in community acupuncture clinics, acupuncture is often not a low cost treatment.
3. In the event of all acupuncturists having access to all patients, there probably aren’t enough acupuncturists for all patients to access (as Elaine Wolf Komarow has pointed out in previous blog posts). Acupuncture will still be provided by non-LAc’s in many places. This scenario is unknown and we can only guess, but chances are, there aren’t enough licensed acupuncturists to go around for the expected 80 million new patients.
4. (Edited for clarification) Ms Friedman is absolutely right in stating that part of our problem is skyrocketing education costs and the situation being made worse with students being told that paying even more for the doctorate is in their best interests. I’m grateful that the NCCAOM acknowledges this. The way to fix the problem of overpriced education for more hours than needed for entry level isn’t by signing onto Medicare any insurance network. Insurance is one problem that needs to be addressed. Education is another. We will become Medicare providers, no doubt. However, we should’t expect this to solve our tuition woes.
5. Today, without Medicare, LAc’s are often covered by insurance and can treat the same patients other professions treat. We may not be covered by Medicare, but many, many insurances reimburse LAc’s, and the VA and WC certainly do. Other than Medicare, we treat those same patients and get reimbursed for it. More and more insurance companies are including acupuncture.
6. New grads are not being turned down for loans because the banks don’t see them as doctors. In the end, banks don’t care what your profession is. They do care if you’re ‘a good bet’. Comparison to other professions such as chiropractic, physical therapists, or APRN might have been a more helpful example here.
7. Acupuncturists work in hospitals and health centers now, and without federal recognition. (I’m assuming she meant ‘recognized as a medicare provider’ when she used the term ‘federal recognition’.) The trend of hiring acupuncturists is already there and the number of jobs in these settings will continue to increase. Admittedly, Medicare inclusion will speed this process up, but let’s admit that it’s already happening.
8. Medicare inclusion will not end ‘scope encroachment’. Medicare has nothing to do with scope. States will continue be free to add acupuncture to the scopes of other professions. Besides, other professions that currently have acupuncture in their scope of practice (other than MD’s) still need an acupuncture license and/or NCCAOM certification to be reimbursed by Medicare for delivering the service to its beneficiaries. Those are the current CMS guidelines concerning acupuncture.
9. Again, the adamant assertion that ‘the option to opt out will always be your option to choose’. We don’t even know if we’ll have an opt-out option until the bill is signed into law.
10. And again, the statement that individual practices will not have to change. Yes, they will, and some in a big way. If individual practices choose not to enroll as providers at all, they will loose their senior patients. They will not be able to bill Medicare and will be prohibited from accepting cash from beneficiaries for covered Medicare services. This is constantly overlooked. It’s something we will just have to deal with, and our leaders should admit this so we can prepare. Maybe they ould even help us prepare.
11. ‘Medicare inclusion is the first and only step we have right now.’ No, it’s not. But it is the one we have chosen and we are moving forward with it. We’ve been hearing that Medicare is our only option since Day One of the Chu bill (and before).
Lastly, I agree with Lisa Rohleder about the tombstones. Nice touch, NCCAOM!
Thanks, Kate. This is the perfect place for this dialogue.
You make a bunch of great points. The NCCAOM and ASA must know that a bunch of what they are saying is bs – because it’s been pointed out to them before. That they can get any traction with their argument that in the 80’s only LAcs were doing acupuncture is a sign of just how much the “old guard” has been silenced and ignored. And anyone who believes that Medicare inclusion will help protect scope is blind to what is happening in the rest of medicine and economics. When a third party is paying the bills, they will always chose the cheapest option. And that won’t be us with our 1000’s of hours of training.
Unfortunately, they are holding the microphone, so their message is all most of our colleagues will ever hear.
Oh my goodness – can you link us to the article where New Rule for old guard practitioners was proposed? I knew this to be true, but to have it so bluntly and publicly stated . . .
This is doubly discouraging in a profession that has historically relied on the wisdom of its ‘old guard’.
It was in a private email to me. Along with threats if I disclosed what was said. I haven’t really decided what to do at this point — it’s hard to imagine the threats could be more than a bunch of social media harassment, so I don’t know that it’s enough to dissuade me. But I also don’t feel like dealing with it.
But also – it’s been obvious that that’s the case for awhile, even if was never said.
Follow your instincts and don’t disclose, then. This info is enough – you’ve kept me from a search through AT articles, which I was not looking forward to.
I definitely don’t want you to do that. More will (probably) be revealed.
And, I think words to that effect have been said many times before. I think in the Fall Town Hall Mr. Taromina said something like you need to work for this for the good of the future, even if it isn’t good for you….
Thank you for this post. I want to superhero style send you a reminder of the beautiful power you have and have harnessed over many, many, many moons. Thank you for reminding the acupuncture world about Lisa. I am a POCA Tech grad and I am so darn fortunate to have attended and graduated from such a progressive institution.
Thank you, Jamie. That means a lot.
It is truly amazing to me that someone who has such an ongoing and significant impact on the delivery of acupuncture is so unknown by so many in the profession. We do have this weird situation where folks who had a big role in so many of the profession’s missteps continue to be the ones driving the ship, and those who have been calling out warnings get dismissed. Or worse.
Thank you for your clarity and willingness to try to communicate it. You are a gift!